Management of Adult Acquired Buried Penis

Buried penis is a condition in which the penis becomes engulfed by surrounding skin or fat pads. It causes partial to complete obstruction (Cohen, Cureus 13(2):e13067, 2021, Ho and Gelman, Transl Androl Urol 7(4):618–27, 2018). Buried penis can affect both juvenile and adult males. The chapter will focus on adult acquired buried penis (AABP). While AABP can result from genital lymphedema, hidradenitis suppurativa, or excessive fibrosis from surgical procedures such as repeated circumcision, AABP most commonly results as a comorbidity from severe obesity (Ho and Gelman, Transl Androl Urol 7(4):618–27, 2018). Buried penis is devastating to quality of life. Associated outcomes include depression, sexual dysfunction, problems voiding, recurrent infections, and worsened self-image (Cohen, Cureus 13(2):e13067, 2021). As obesity becomes more prevalent, the incidence of buried penis will likely increase as well, therefore requiring more comprehensive understanding and classification of treatment. Currently, management relies on surgical intervention as weight loss only mildly improves symptoms (Jun et al., BJU Int. 2018;122(4):713–5, Pekala et al., Urology 133:229–33, 2019). Depending on classification of the condition, surgical intervention can range from abnormal skin excision with skin graft to multidisciplinary penis reconstruction (Flynn et al., Urol Clin N Am 2022;49(3):479–93, Pariser et al., Urology 120:248–52, 2018). While minor post-operative complications are quite common, major complications are rare (Falcone et al., Eur Urol 131(1):8–19, 2022). Additionally, outcomes of surgical management are positive, with significant improvements to mood, penile hygiene, social life, romantic and sexual relationships, sexual satisfaction, self-image, and urinary function (Amend et al., J Urol 206(Supplement 3):18, 2021, Falcone et al., Eur Urol 131(1):8–19, 2022, Flynn et al., Urol Clin N Am 2022;49(3):479–93, Pekala et al., Urology 133:229–33, 2019). As buried penis becomes a more common phenomenon, it is necessary for providers from multiple disciplines to better understand how to classify and treat this condition to maximize the outcomes and improve the well-being of impacted patients.